Study Suggests Delayed Diagnosis of AS is Linked to Greater Incidence of Uveitis and IBD

6/8/23

According to a study recently published in Rheumatology (Oxford), extra-musculoskeletal manifestations (EMM) such as uveitis and inflammatory bowel disease (IBD) may be more common in patients with ankylosing spondylitis (AS) who experience longer diagnostic delays than in those with psoriatic arthritis (PsA).

This study examined the prevalence of EMMs in patients with AS and PsA and whether diagnostic delay influences their presence. Researchers collected data from three groups: two European groups and one Latin American group. In total, 3553 patients were included in the study (2097 with AS and 1456 with PsA). Though diagnostic delay was similar among all groups, patients in the Latin American group with AS were younger and had a shorter disease duration than those in the European cohort.

Cox proportional hazards (statistical models commonly used in medical research to make predictions) were used to examine the association between diagnostic delay and incidence of EMM. Overall, the prevalence of EMMs was more common in patients with AS compared to patients with PsA. Uveitis was a more common EMM than inflammatory bowel disease.

For uveitis, 45.1% of patients with AS compared to 33.3% of patients with PsA reported their first episode of uveitis occurring before the diagnosis. In addition, 37.4% of patients report being diagnosed with IBD before AS, while 70% of patients with IBD and PsA report being diagnosed with IBD before AS. Patients with AS with a diagnostic delay of at least 5 years reported more episodes of uveitis and IBD. This association was not observed among patients with PsA.

Researchers noted that the study had some limitations: EMM characteristics were collected from clinical notes and patients’ memories, and patients were included in the study based on diagnosis from a clinician rather than validated diagnostic criteria for AS and PsA.  Nonetheless, researchers conclude that the study emphasizes the need for doctors across specialties to collaborate to create better diagnostic strategies for these diseases that affect multiple body systems.

Resources:

1. Longer Diagnostic Delay Associated With Greater Incidence of Uveitis, IBD in AS
2. Eye, Yai, Yai: Iritis, The Eye, and the Immune System in Axial Spondyloarthritis